Does 780+CGM restrict insulin to NovoRapid & Humalog?

[MJS007]

I have recently had word that my healthcare team are finally able to provide me with G4; however, there is a catch!...

They have advised its conditional on changing from unsupported Fiasp which they themselves prescribed two years back for pre-bolus and sensitivity issues which is currently working well for me back to NovoRapid or Humalog being apparently the only two licenced insulins for 780 Pump + CGM use.

They haven't given me a clinical reason other than Fiasp isn't licenced in closed loop and are not taking into consideration the fact I moved away from NovoRapid two years ago so concerned I'm taking a step backwards.

I was just wondering if anyone else has run into this issue? or is in fact using Fiasp happily in closed loop?

 

[nonethewiser]

Be interested in answers, use fiasp myself in omnipod pump & wouldn't want to switch back to NR, don't even know if it's licenced for my pump if honest.

 

[Inka]

@MJS007 Are you going to be looping? Have they explained exactly why Fiasp ‘isn’t licensed’?

 

[rebrascora]

Isn't it to do with the looping algorithm being tied to the insulin working over 5 hours whereas Fiasp is pretty well gone in 3hrs.

 

[Pumper_Sue]

Isn't it to do with the looping algorithm being tied to the insulin working over 5 hours whereas Fiasp is pretty well gone in 3hrs.

Fiasp does work for 5 hours.
Even though you feel the most effect within the 3hrs duration is actually 5. I experimented with my pump and CGM, near the end of the 5 hours it gives a final kick as an extra bonus.

 

[everydayupsanddowns]

@MJS007 Are you going to be looping? Have they explained exactly why Fiasp ‘isn’t licensed’?

I think it’s because Fiasp is still too ‘new’, and device manufacturers haven’t checked it out (and gone through tortuous regulatory hoops) yet?

 

[Inka]

I think it’s because Fiasp is still too ‘new’, and device manufacturers haven’t checked it out (and gone through tortuous regulatory hoops) yet?

I use an ‘unlicensed’ insulin in my pump. I thought the only issue was adjusting the settings like duration of action, but assumed a loop might not be so easy to use with a different insulin?

 

[everydayupsanddowns]

I use an ‘unlicensed’ insulin in my pump. I thought the only issue was adjusting the settings like duration of action, but assumed a loop might not be so easy to use with a different insulin?

Yes I’d imagine the onset time and overall curve of action must be factored in there somewhere - if nothing else to calculate ‘insulin on board‘.

My impression of Fiasp is that the duration is similar to NR, but that more of the ‘oomph’ acts earlier.

This by Tim Street at Diabettech was interesting on the overall subject.

Why DIA values are wrong | Diabettech - Diabetes and Technology

The values that we use for DIA in pumps and bolus wizards is wrong. Here's why and what you can do about it.

www.diabettech.com

 

[Inka]

Very interesting @everydayupsanddowns Thank you for the link 🙂 I never use the bolus calculator on my pump and never have. I put the duration of action in my pump to make the trainer happy, then told him I’d be using my own calculator - my brain

 

[MJS007]

Isn't it to do with the looping algorithm being tied to the insulin working over 5 hours whereas Fiasp is pretty well gone in 3hrs.

@MJS007 Are you going to be looping? Have they explained exactly why Fiasp ‘isn’t licensed’?

Hi Inka, to be honest I'm not to bothered about looping it's more about using the sensor compatible with my pump so I don't keep having to input values from my Libra but yes I guess I would also be keen to enable looping when appropriate. No just that it's not licenced but not sure where they are looking for a licence, the Fiasp insulin manufacturer and emc states its suitable for use in a pump so from their perspective it's ok

 

[MJS007]

Fiasp does work for 5 hours.
Even though you feel the most effect within the 3hrs duration is actually 5. I experimented with my pump and CGM, near the end of the 5 hours it gives a final kick as an extra bonus.

Hi Sue, the action time is very similar and Fiasp is actually modified NovoRapid, it's just the onset time is better with Fiasp so you don't need to pre-bolus quite so much.

 

[MJS007]

Isn't it to do with the looping algorithm being tied to the insulin working over 5 hours whereas Fiasp is pretty well gone in 3hrs.

Yes I’d imagine the onset time and overall curve of action must be factored in there somewhere - if nothing else to calculate ‘insulin on board‘.

My impression of Fiasp is that the duration is similar to NR, but that more of the ‘oomph’ acts earlier.

This by Tim Street at Diabettech was interesting on the overall subject.

Why DIA values are wrong | Diabettech - Diabetes and Technology

The values that we use for DIA in pumps and bolus wizards is wrong. Here's why and what you can do about it.

www.diabettech.com

Hi, yes your spot on the action time is similar just the onset time is quicker with Fiasp which is why I was switched to it a couple of years ago to assist with pre-blousing as was having to do 20-25mins prior with NovoRapid.

On the pump you can configure the action time but not the onset time and whilst like yourself I thought you would select the type of insulin and it would work to an appropriate curve it seems it's not as scientific as this, maybe in their next update.

My point has been if I'm successfully using it in my pump already, introducing CGM standalone introduces zero risk (better xDrip which I currently use to grab data from Libre) but enabling SmartGuard should reduce risk considerably with the main risk being hypos so just don't get their reasoning

 

[Pumper_Sue]

Hi Sue, the action time is very similar and Fiasp is actually modified NovoRapid, it's just the onset time is better with Fiasp so you don't need to pre-bolus quite so much.

I've used Fiasp since it first came out so know exactly how it works 🙂